The pros and cons of Prednisone

Posted by jlo2252 @jlo2252, Jun 10 3:26am

Hello. My name is Jean and I’m new to this group. I feel like I have a unique perspective regarding the “evil” steroid drug prednisone…. I have been reading your comments for a few months now but just recently commented on this forum.
I had very severe asthma as a child and would of died without steroid injections and oral prednisone. So would of both of my children, who genetically got their asthma from me.
In my early 20’s I was diagnosed with Reiter’s Syndrome, today known as Reactive Arthritis. The only medicines they had in those days were a anti inflammatory called Indocin, Aspirin and Predisone—that was it! The pain was unbearable and I was hospitalized and diagnosed and treated by my PCP and a Rheumatologist. I had the arthritis symptoms for a year, then by a miracle, went into remission for 20 years! After that time it comes and goes infrequently. I have had PMR off and on for about 2 years. This has been my lifesaving journey taking prednisone for pain and being able to breathe!!
Ok, now all this has, of course, had its toll on my body. I’m 74 years old and I have Osteoporosis. I’m taking a yearly infusion of Reclast for this (can’t take the oral medication) and taking calcium/magnesium supplements.
I have the thin, crepy skin on my forearms and hands. No real cure for that—just use a good moisturizer.
I’m also a diabetic, but this is more to do with the genetics in my family —my mom, grandma, brother and sister all had/have it and they never took prednisone.
My rheumatologist wants me off predisone (I’m taking 7.5 mg.) and he concurrently wants me to be on Actemra. I getting over a mild bronchitis and then I can start that. My immune system is also not the greatest.
Anyway, despite all of my health issues, I’m grateful and in awe of the magic of predisone for my breathing and pain relief!
Thanks for listening!

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

@bobroberts

Hello I am an English male 76 and resident in France, I was diagnosed with PMR 13 months ago under the most amazingly good care of the French health system. . I could not walk and the pain in my shoulders meant difficulty getting in and out of bed, I could not roll over because of shoulders and hip pain. Dressing was difficult, socks and shoes impossible to put on myself.
Diagnosis was confirmed by PET scan with infusion and my immediate successful reaction to 20mg daily Prednisone. I thought I had made a complete recovery in a month or two but then the dreaded flare-ups start. In some ways they were worse than the original problem.

I found comfort sitting in my armchair and on one occasion slept for four nights sitting up in it. Prenisone was increased to 30mg and then down to 25 before returning to 20mg.
I had a bone density scan in which found my bone density had fallen, this is caused by Prednisone depleting the calcium. I am not able to walk very far.
During this year my vision has become affected and regular visits to the Opthamologist has shown a significant increase in occular pressure, she was horrified that I was on 20mg and is endevouring to reduce the pressure with eye drops.
After 12 months my doctor referred me to the Rheumatologist who felt that I was in remission and started the taper 17mg for one week 15mg for the next two etc. While I was there he took Xrays and arranged a CAT scan

He found four fractures in my vertebrae, the worse being in my sacroilliac which is why I can't walk more than a few hundred yards. He is quite clear that this is caused by Prednisone.
The corrective procedure for the calcium depletion will be an injection a day for the next two and a half years!
I have taken other damage to knee cartilage and excruciating PMR groin pain has now become a suspected hernia, I await an ultrasound examination in two weeks time.
The conclusion to this saga is what one of the forum members have already said "PREDNISONE IS NOT ALWAYS YOUR FRIEND" it is a cruel compromise between being crippled, loosing your eyesight, and having a catalogue of damaging side effects.
I could have started the taper earlier but was still in discomfort and feared the return of pain.

My advice to you all is never miss the opportunity to taper down if your medics recommend it.

Jump to this post

Hello @bobroberts, Welcome to Connect. Thank you for sharing your experience treating PMR. I agree that prednisone is not always our friend but sometimes is the only game in town to help. My rheumatologist had me keep a daily log of my pain level in the morning and the dosage amount for the day when tapering down to get off of prednisone. He also emphasized that I need to listen to my body and if my pain level was too high then to slow the taper a little or wait a week or so.

Do you keep a daily log?

REPLY
@bobroberts

Hello I am an English male 76 and resident in France, I was diagnosed with PMR 13 months ago under the most amazingly good care of the French health system. . I could not walk and the pain in my shoulders meant difficulty getting in and out of bed, I could not roll over because of shoulders and hip pain. Dressing was difficult, socks and shoes impossible to put on myself.
Diagnosis was confirmed by PET scan with infusion and my immediate successful reaction to 20mg daily Prednisone. I thought I had made a complete recovery in a month or two but then the dreaded flare-ups start. In some ways they were worse than the original problem.

I found comfort sitting in my armchair and on one occasion slept for four nights sitting up in it. Prenisone was increased to 30mg and then down to 25 before returning to 20mg.
I had a bone density scan in which found my bone density had fallen, this is caused by Prednisone depleting the calcium. I am not able to walk very far.
During this year my vision has become affected and regular visits to the Opthamologist has shown a significant increase in occular pressure, she was horrified that I was on 20mg and is endevouring to reduce the pressure with eye drops.
After 12 months my doctor referred me to the Rheumatologist who felt that I was in remission and started the taper 17mg for one week 15mg for the next two etc. While I was there he took Xrays and arranged a CAT scan

He found four fractures in my vertebrae, the worse being in my sacroilliac which is why I can't walk more than a few hundred yards. He is quite clear that this is caused by Prednisone.
The corrective procedure for the calcium depletion will be an injection a day for the next two and a half years!
I have taken other damage to knee cartilage and excruciating PMR groin pain has now become a suspected hernia, I await an ultrasound examination in two weeks time.
The conclusion to this saga is what one of the forum members have already said "PREDNISONE IS NOT ALWAYS YOUR FRIEND" it is a cruel compromise between being crippled, loosing your eyesight, and having a catalogue of damaging side effects.
I could have started the taper earlier but was still in discomfort and feared the return of pain.

My advice to you all is never miss the opportunity to taper down if your medics recommend it.

Jump to this post

"My advice to you all is never miss the opportunity to taper down if your medics recommend it."

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Good advice ... but a doctor's duty is to make the tapering process as painless as possible. I was never pressured to taper lower. In fact, my doctors were very liberal with giving me enough prednisone. Once I somewhat accused my rheumatologist that she only prescribed me prednisone because she thought prednisone was what I wanted. I wrote that message as tactfully as I could.

After that message, my rheumatologist and I had a heart to heart discussion. I admitted to her that I simply could not taper off Prednisone and "refused" to try because it was too painful. Not long afterwards, something new was tried. Actemra was FDA approved for GCA but not for PMR so my rheumatologist needed to get Actemra approved for me before prescribing it.

I almost refused Actemra because some people said Prednisone was the "only option" for PMR. They actually called my rheumatologist some names and said doctors in the USA were "breaking the rules" by giving me Actemra for PMR.

To be honest---Prednisone was never my friend but I did have a love/hate relationship with it. I think many Europeans are now getting PMR/GCA treated with biologics on a case by case basis. I recall someone in France and also Germany and both had good results. Some people don't have good results.

I'm glad you are getting amazingly good care from the French health system. Too many people blame the health care system and doctors for their woes. I never felt like anyone or my health care system caused my pain and my inability to taper off prednisone. I believe people don't always have the best access to health care when they need it. There are simply too many unknowns to cast blame on anyone. I can't blame Prednisone either because, until recently, Prednisone was the best treatment for PMR ... Maybe things will change in the future.

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@linda7

I agree with you about wanting to maximize function and accept some long term risk in order to enjoy life in the present. My situation is a little different in that I'm younger (74) and on a lower dose of prednisone ( 6 mg which is about like 1 mg dexamethasone). I have started Kevzara which has possible cancer and other risks. I watch my labs and blood pressure and so far they look good. My rheumatologist says that 5 mg of prednisone and below is significantly safer so I am trying to get there. I'd like to get to 3 mg and wouldn't mind staying there long term if I feel good and am not having side effects. It's a personal decision balancing a lot of factors.

Jump to this post

My rheumatologist said basically the same thing, "If I only needed 3 mg for the rest of my life ... there wouldn't be much risk at that dose." He wouldn't have even considered Actemra.

REPLY

Hi. I'm also new to the group, and in my 70's☺️. Very much agree with you about the prednisone. It literally gave me my life back. The side effects and the unpredictable flares are bothersome, discouraging. But I'd be in a nursing home without the magic of prednisone.

REPLY

Hi Everyone.
I recently connected to this site. I'm a 71 y/o female & I was diagnosed with PMR in Oct. of 23, 7 mos. after rotator cuff surgery. Was my pmr caused by the stress of surgery?? who knows?? I couldn't believe how stiff my hips & shoulders became.
I was started on 50mg of prednisone and was able to taper to 30 mg pretty quickly and am down to 5mg now and have only occasional pain & stiffness in my non surgical shoulder. Thank goodness my primary care physicians assistant knew immediately I had PMR. I'm presently seeing a rheumatologist every 3-4 months for lab work. My labs, crp & esr, have improved significantly on prednisone.
I've remained active, going to yoga and tai chi, which I think have really helped me physically & mentally. I also play tennis when I can. Some people say an anti inflammatory diet helps. Can't say that for sure, but I've tried to eliminate most sugar.
I HATE being on prednisone and will continue to taper. I'd love to just stop cold turkey, but that is not smart.
It's definitely a slow journey but staying positive helps! My mantra is " This too shall pass!" I wish the same for everyone with this diagnosis. Hang tough!

REPLY
@judygref

Hi Everyone.
I recently connected to this site. I'm a 71 y/o female & I was diagnosed with PMR in Oct. of 23, 7 mos. after rotator cuff surgery. Was my pmr caused by the stress of surgery?? who knows?? I couldn't believe how stiff my hips & shoulders became.
I was started on 50mg of prednisone and was able to taper to 30 mg pretty quickly and am down to 5mg now and have only occasional pain & stiffness in my non surgical shoulder. Thank goodness my primary care physicians assistant knew immediately I had PMR. I'm presently seeing a rheumatologist every 3-4 months for lab work. My labs, crp & esr, have improved significantly on prednisone.
I've remained active, going to yoga and tai chi, which I think have really helped me physically & mentally. I also play tennis when I can. Some people say an anti inflammatory diet helps. Can't say that for sure, but I've tried to eliminate most sugar.
I HATE being on prednisone and will continue to taper. I'd love to just stop cold turkey, but that is not smart.
It's definitely a slow journey but staying positive helps! My mantra is " This too shall pass!" I wish the same for everyone with this diagnosis. Hang tough!

Jump to this post

Hello @judygref, Welcome to Connect. I love the can do attitude! I think we all hated being on prednisone but oh that relief when it works. Slow and easy definitely helps with the tapering, at least for me anyway. My rheumatologist had me keep a daily log of my pain when I got up in the morning along with my dose for the day. When it came time for me to taper, he had me listen to my body. If my pain was significant (a 2 or above on my scale of 1 to 10), then we went a little longer on the same dose or bumped it up half of the last taper down to see if that controlled the pain. I also found that if I overdid any activity that could cause a flare up.

Do you keep a daily log?

REPLY
@johnbishop

Hello @judygref, Welcome to Connect. I love the can do attitude! I think we all hated being on prednisone but oh that relief when it works. Slow and easy definitely helps with the tapering, at least for me anyway. My rheumatologist had me keep a daily log of my pain when I got up in the morning along with my dose for the day. When it came time for me to taper, he had me listen to my body. If my pain was significant (a 2 or above on my scale of 1 to 10), then we went a little longer on the same dose or bumped it up half of the last taper down to see if that controlled the pain. I also found that if I overdid any activity that could cause a flare up.

Do you keep a daily log?

Jump to this post

I log my dosage on my calendar & try to stay on the same dose for 2 weeks at a time.
I have had minor increases in pain if I overdue my activity. Try to take Tylenol, sometimes Aleve, to get me through. Doesn't happen too often.

REPLY

I have been on this site for a little over 2 weeks. I have tried to be somewhat vocal on my opinion about prednisone and life hereafter. I just turned 72. I grew up with Asthma. I passed it on to one of my 3 daughters. I always treated it with OTC. I unfortunately came to be associated with steroids when my wife acquired GBM 3 years ago. I am her caretaker. The drug has ravaged her body yet everyone says well just keep her comfortable. She is on hospice. She is on 5 mg of prednisone equivalent. We both have always been active. She is 71. I acquired PMR 2 years ago. Knowing the issues with steroids it was my only savior. But I quickly (6 months) got off. I cannot get my wife off. Inflammation in the brain is not negotiable. At 72 I have plenty left. No other issues in my life. I dont want to be a burden so I need to approach life as responsibly as possible. I am not ready to say there is nothing I can do about it. I want to understand my disease and take steps to continue forward. I dont see living to 100. But I am not ready to accept that its over. There is a normal life after prednisone. It is possible to be pain free and PMR doesnt have to be a shortened life expectancy. Its not like GBM. Cheers to the next 20+ years.

REPLY

So after reading all your posts,
my own conclusion is that prednisone is both a blessing and a curse! It does have some not so good long term side effects, which in my mind don’t look as bad as the potential side effects as some of the other biologics and anti-inflammatories mentioned!

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@jlo2252

So after reading all your posts,
my own conclusion is that prednisone is both a blessing and a curse! It does have some not so good long term side effects, which in my mind don’t look as bad as the potential side effects as some of the other biologics and anti-inflammatories mentioned!

Jump to this post

I think your conclusion is valid. However, doctors generally believe a person who takes these other anti-inflammatory DMARDs and biologic medications, may need less of another type of treatment --- corticosteroids.

Unfortunately, it is hard to weigh the pros and cons of alternatives until you try the alternatives.

Thanks for posting your question about the pros and cons of Prednisone.

REPLY
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